Nasal cannula

ABSTRACT

The disclosure relates to a nasal cannula comprising a port configured for delivery of a medicament into a flow of a fluid being delivered by the nasal cannula to a user and/or configured for interfacing with a medicament delivery device or an instrument. The disclosure also relates to a nasal cannula comprising an asymmetric profile to reduce an amount of occlusion of one nare of a user to provide access for an instrument to the nare with the nasal cannula in use.

BACKGROUND Field of the Disclosure

The present disclosure generally relates to nasal cannulas for providinga flow of respiratory gases to a patient, and particularly nasalcannulas for interfacing with an airway instrument and/or a medicamentdispensing device, and/or cannulas that allow redirecting or controllingof gas flow.

Description of the Related Art

Patients may lose respiratory function during anaesthesia, or sedation,or more generally during certain medical procedures. Prior to a medicalprocedure a patient may be pre-oxygenated by a medical professional toprovide a reservoir of oxygen saturation, and this pre-oxygenation isgenerally carried out with a bag and a face mask. Once under generalanaesthesia, patients must be intubated to ventilate the patient. Insome cases, intubation is completed in 30 to 60 seconds, but in othercases, particularly if the patient's airway is difficult to traverse(for example, due to cancer, severe injury, obesity or spasm of the neckmuscles), intubation will take significantly longer. Whilepre-oxygenation provides a buffer against declines in oxygen saturation,for long intubation procedures, it is necessary to interrupt theintubation process and reapply the face mask to increase the patient'soxygen saturation to adequate levels. The interruption of the intubationprocess may happen several times for difficult intubation processes,which is time consuming and puts the patient at severe health risk.After approximately three attempts at intubation the medical procedurewill be abandoned.

A nasal cannula is used to provide a flow of gases to a patient or uservia the patient's or user's nasal passages. A nasal cannula typicallyhas two prongs, each prong adapted to fit within a patient's nostril. Incertain procedures that require intubation, for example in generalanesthesia where a patient is not spontaneously breathing, the insertionof instruments or tubes into a patient's airway may be obstructed orprevented if a nasal cannula were to be used simultaneously with otherairway instruments. In some situations, it may be desirable to use anasal cannula simultaneously with other airway devices or instruments.For example, respiratory gases provided at high flow rates can deliver alevel of pressure that may help to keep a patient's airway open.Therefore it may be desirable to use a high flow cannula on a patient tomaintain a patent airway during anesthesia, where intubation of a tubeor other instrument via the patient's nasal passage is necessary.

Delivery of drugs (i.e. medicament) to a user or patient's airway orparts of their airway may be required for particular reasons. Variousmedicaments can be sprayed or administered into the airway, but themedicament may not reach the desired location, or a useful topicalapplication of such medicament across the airway may not be achieved.

In this specification where reference has been made to patentspecifications, other external documents, or other sources ofinformation, this is generally for the purpose of providing a contextfor discussing the features of the invention. Unless specifically statedotherwise, reference to such external documents is not to be construedas an admission that such documents, or such sources of information, inany jurisdiction, are prior art, or form part of the common generalknowledge in the art.

SUMMARY

It is therefore an object of this disclosure to provide a cannula whichwill go at least some way towards addressing the foregoing problems orwhich will at least provide the industry or public with a useful choice.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises a port configured for delivery of a medicamentinto a flow of a fluid being delivered by the nasal cannula to a userand/or configured for interfacing with a medicament delivery device oran instrument.

The port may comprise a guide for directing a flow of medicament intothe flow of fluid, or for directing the medicament delivery device orthe instrument into the nasal cannula and/or the user's airway.

The guide may provide for a pre-determined geometry of the port todirect, locate or position the medicament delivery device or instrumentor an outlet of the medicament delivery device or instrument at adesired angle or orientation relative to the nasal cannula.

The guide may be configured to provide a clearance between the guide andthe medicament delivery device or the instrument.

The nasal cannula may comprise at least one nasal prong or a pair ofnasal prongs.

The port may be located upon a nasal prong of the nasal cannula, orwherein the interface comprises two ports, each port located upon eachof a pair of nasal prongs.

Alternatively the port may be located on a manifold part of the nasalcannula.

The port may be located on the manifold part so that a path through theport is aligned with a flowpath through a nasal prong of the nasalcannula.

The port may be arranged to face away from the patient's face in use.For example the port may be provided on a wall of the cannula that facesaway from the face of a patient in use.

The nasal cannula may comprise a moulded or otherwise shaped regionsuitable for accepting or receiving or locating or seating of themedicament delivery device or the instrument relative to the port.

With the medicament delivery device or the instrument in-situ with theport, the port may seal about the medicament delivery device or theinstrument.

The port may comprise a closable or re-closable opening.

The port may comprise of a self-closing seal.

The port may include a relatively rigid component to support themedicament delivery device or the instrument when in-situ with the port.

The cannula may include structures or elements for an in-lineatomisation or nebulisation of medicament dispensed or administered ordelivered via said port.

The port may include the structures or elements for an in-lineatomisation or nebulisation of medicament dispensed or administered ordelivered via said port.

The structures or elements may be ribs or serrations within the nasalprong.

The port may be a channel in an outer surface of a nasal prong of thenasal cannula.

A nasal prong of the cannula may be a multi-lumen prong, and wherein oneof said lumen may provide the port for inserting the medicament deliverydevice or instrument.

The nasal cannula may comprise a medicament supply tube extending fromthe port.

The supply tube may extend from the port to an outlet end of a nasalprong of the nasal cannula.

An outlet end of the tube may be located at an inward side of the nasalprong to be located adjacent to the patient's septum in use.

The supply tube may be formed within a wall of a nasal prong of thenasal cannula.

The supply tube may be located within a lumen of a nasal prong of thecannula.

The supply tube may be located approximately centrally within the lumenof the nasal prong of the nasal cannula.

The port may be an inlet end of the supply tube.

An inlet end of the supply tube may extend from a manifold of thecannula so that the medicament delivery device may be connected to theport remotely from the manifold.

The supply tube may comprise a small diameter outlet, such that theoutlet operates as a nozzle to spray or otherwise disperse themedicament from the supply tube.

The port may be adapted to receive a nozzle or outlet of the medicamentdelivery device or to be received in a nozzle or outlet of themedicament delivery device.

The instrument may be an airway tube or conduit, an introducer/bougie, astylet, a guide, a tube exchanger, or a scope or diagnostics instrumentsuch as an endoscope, a rigid or flexible bronchoscope, an esophagoscopeor a fibreoptic scope.

The relatively more rigid component may provide a surface for positiveorientation or definition of a secure location or seating position for adispenser.

The relatively more rigid component may provide for a pre-determinedangle of insertion by the dispenser to the port.

The port may comprise a relatively softer or more flexible orcompressible component that seals over the port.

The port may comprise a covering of a relatively elastic or elasticatedcover material that stretches when the dispenser is inserted and allowsextension, optionally a seal is said elastic or elasticated covermaterial.

The port may be formed of a combination of a relatively more rigidcomponent and a covering material of at least one layer of a relativelycompressible material.

The port may allow for insertion of a relatively long medicamentdispenser or instrument.

The relatively long medicament dispenser or instrument may be a conduitor tube to be extended to project along at least a length of or throughthe flowpath of the patient interface or a component such as a gassupply conduit associated with the interface.

The dispenser when in-situ with the port, may provide for a medicamentdispenser outlet termination at the flowpath outlet from one or more ofsaid nasal prongs, or said a medicament dispenser outlet may terminatewithin the flowpath (i.e. upstream of the flowpath outlet from one ormore nasal prongs) or may terminate at a position beyond the flowpathoutlet of the one or more nasal prongs (i.e. downstream of the flowpathoutlet from the one or more nasal prongs).

Insertion or connection of the medicament dispenser with the port maypromote a protrusion (e.g. such as a lumen provided) to extend along andthrough the flowpath.

Insertion of the dispenser may promote the protrusion to extend from theport along and through the flowpath and along and through one or morenasal prongs.

The protrusion may further comprise corrugations or otherconcertina-type arrangements that can unfold and extend to allow anextension or lengthening of the protrusion.

Extension of the protrusion may allow for an outlet of the protrusion toextend beyond or past the end of one or a pair of nasal prongs, or otherstructures associated with a patient interface.

The protrusion may be curved or shaped or configured for nasalanatomical fit.

The protrusion in an extended configuration may reduce, minimise orprevent flow of gases along the flowpath, optionally the protrusion mayreduce, minimise or prevent flow of gases through a nasal prong orprongs.

A pressure relief system or, device or arrangement may be associatedwith the flowpath for relief of pressure above a pre-determined pressurelevel.

A recirculation system or scavenging system may be combined with theinterface for collection of gases from the flowpath not delivered to theuser, or which are exhaled by the user, said gases to be filtered andreturned to the user (e.g. non-administered medicament may be retrievedand returned to the user).

One or a pair of nasal prongs may be relatively long, such that one oreach nasal prong may extend relatively deep into a user's nasal cavity,optionally, one or both nasal prongs may be curved to conform to nasalgeometry.

There may be provided a patient interface, such as a nasal cannula,comprising one or a pair of nasal prongs that may be extendable orcomprise portions or protrusions extendible in length.

A nasal prong comprises an inner secondary prong portion (such as aprotrusion) including corrugations or concertina-type sections forlengthening of the inner secondary prong portion (or said protrusion).

The dispenser may comprise a reservoir of pre-formulated medicament of apre-determined quantity, optionally in a ready-to-dispenseconfiguration.

The patient interface, or a component associated with the patientinterface (such as a gas supply conduit) may comprise one or morereservoirs for receiving and/or storing of a medicament.

The reservoir may be actuated mechanically, electronically or manuallyor by other forms to controllably release medicament into a flowpath.

In accordance with at least one of the embodiments disclosed herein, apatient interface comprises at least one gas delivery element (such as anasal prong in a nasal cannula), wherein said gas delivery element issized or shaped so as to provide for in-line atomisation or nebulisationof a medicament to be delivered to a user through a gas flowpath.

A nasal prong may be a gas delivery element, said nasal prong comprisinga relatively small internal diameter, or other internal structures inthe gas flowpath, so as to create high gas velocities in the gasflowpath through the prong.

Multiple gas delivery elements may be provided, each such elementproviding for a separate gas flowpath for medicament dispensing,delivery or administration.

The gas delivery element may be a nasal prong.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises one or a pair of nasal prongs, one or each ofsaid nasal prongs comprising of a shaped or otherwise curved region foraccommodating a medicament dispenser adjacent to said prong when in thenare of a user's nose.

In accordance with at least one of the embodiments disclosed herein, anapparatus for delivering a medicament to a user comprising a medicamentdelivery device or instrument and a nasal cannula as described in anyone or more of the above statements, the port and the medicamentdelivery device or instrument complementarily adapted such that with themedicament delivery device or instrument in-situ with the port an outletof the medicament delivery device or instrument is located: (i) at anoutlet of a nasal prong of the nasal cannula, or (ii) at a smalldistance beyond the outlet of a nasal prong downstream of the nasalcannula.

The apparatus may comprise the medicament delivery device and whereinthe medicament delivery device may comprise a reservoir ofpre-formulated medicament of a pre-determined quantity, optionally in aready-to-dispense configuration.

In accordance with at least one of the embodiments disclosed herein a,nasal cannula may comprise an asymmetric profile to reduce an amount ofocclusion of one nare of the user to provide access for an instrument tothe nare with the nasal cannula in use.

The cannula may be asymmetric in plan view and/or when viewed from thefront. The cannula may have a frame or manifold part and one nasal prongor a pair of nasal prongs extending from the frame or manifold part, andthe frame or manifold part may be asymmetrical.

The frame or manifold part may have a thickness extending between abackside of the cannula that locates against or adjacent the user's facebelow the user's nose and an opposite outwards front side of thecannula, and the thickness adjacent one nare of the user may be lessthan the thickness adjacent the other nare of the user.

The frame or manifold part may have a height extending between a top ofthe frame or manifold part and a bottom of the frame or manifold part,and the height adjacent one nare of the user may be less than the heightadjacent the other nare of the user.

The nasal cannula may comprise a pair of nasal prongs and wherein one ofthe pair of nasal prongs may have an oval cross section or a crosssection shaped flatter than a circle to provide a space between theprong and the user's nare for an instrument to be inserted into thenare.

The nasal cannula may comprise a pair of gas outlets, a first gas outletof the pair of gas outlets being a nasal prong and a second gas outletof the pair of gas outlets being prong-less or a second nasal prong thatmay be shorter than the nasal prong of the first gas outlet.

The nasal cannula may comprise a manifold part that receives a flow ofgases and redistributes that flow to each nare of a user via a pair ofoutlets or apertures, each outlet corresponding with a nare of the user,wherein the outlets or apertures may be prong-less.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises two nasal prongs of unequal length.

A shorter one of the prongs may be of a length to have a relativelyminimal or substantially no extension into the nare of a patient in use.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises two nasal prongs, wherein in each prong is of alength to have minimal or substantially no extension into the nares ofthe patient.

In accordance with at least one of the embodiments disclosed herein, acannula is asymmetric to be reduced in size on one side compared to anopposite side.

The cannula may be asymmetrical to reduce an amount of occlusion of theuser's nare on the side of the cannula that is reduced in size.

The cannula may be asymmetrical to provide access to a nare of a user ata side of the cannula that is reduced in size while the cannula is inuse and while the cannula provides flow to at least the other nare, orboth nares.

The cannula may be asymmetric in plan view.

The cannula may be asymmetric when viewed from the front.

The cannula may be asymmetric when viewed from the front of the cannulaand also when viewed in plan view.

The cannula may have a frame or manifold part and two nasal prongsextending from the frame or manifold part.

The frame or manifold part may be asymmetrical.

The nasal prong at the side of the cannula that is reduced in size maybe oval or a shape that is flatter than a circle to provide a spacebetween the prong and the user's nare for an instrument to be inserted.

The asymmetrical cannula may comprise two prongs, or one prong and aprong-less outlet on the reduced in size side of the cannula.

The prong on the reduced in size side of the cannula may be shorter thanthe prong on the other side of the cannula.

In accordance with at least one of the embodiments disclosed herein, acannula comprises a manifold part or frame that receives a flow of gasesand redistributes that flow to each nare of a user via two outlets orapertures, each outlet corresponding with a nare of the user, whereinthe outlets or apertures are prongless.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises a removable or extendable prong.

At least one prong may be retractable into or extendable from a manifoldof the cannula, for example the prong slides into and out of themanifold of the cannula.

One or both prongs of the cannula may comprise corrugations orconcertina type sections which can be extended by a user to lengthen toextend the length of the prong. The corrugations may be formed at a baseof the prong, or partway or fully along the length of the prong.

One or both prongs may be configured to be torn from a manifold part ofthe cannula.

One or both nasal prongs may be removably attached to a manifold part ofthe cannula. The releasable prong may be permanently attached to thecannula assembly, for example by a lanyard or leash.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises a moveable prong that may be moved out ofalignment from a user's nare, while a second prong remains in fluidcommunication with the other nare of the user.

The cannula may comprise a prong that may be slidable relative to theother prong or to a manifold part of the cannula, to displace the prongfrom a user's nare in use.

The nasal cannula may comprise a gas supply rail or conduit (manifoldpart), and one prong may be slidable on the manifold part. The slidableprong may comprise a prong portion to be inserted into a nare of theuser, and a base portion adapted to receive the manifold part to slidethereon. The manifold may comprise an aperture that is exposed when theprong is slid out of alignment with a user's nare, to provide some gasflow from the manifold to the exposed nare of the user.

In accordance with at least one of the embodiments disclosed herein, acannula is configured to optionally provide flow to one nare of a userwhile providing flow to the other nare of the user.

The cannula may comprise one nasal prong to provide a flow of gas to anare of a user, and an opening or aperture in a manifold of the nasalcannula that may be capped or plugged by a cap.

The cannula may comprise a rotatable cuff to block or unblock an openingor aperture on a manifold of the cannula to optionally provide a flow ofgas to one nare of the user. The rotatable cuff may have an aperture toalign with the manifold aperture to allow flow from the manifoldaperture to the user's nare.

Flow to one nare may be optionally provided via a nasal prong.

A nasal cannula may comprise a rotatable prong, may be rotatable on agas supply rail or conduit or manifold part of the cannula (hereincalled a manifold part) between a open position and a closed position.In the closed configuration the prong may be rotated so that the prongis not in fluid communication with the manifold and is out of alignmentwith the user's nare. In the closed configuration, 100% of the flow maybe directed via a second prong into one nare of the user.

Both prongs may be rotatable on a rail or supply conduit or manifold ofthe cannula.

A nasal cannula may comprise a slidable prong, the slidable prong beingslidable on a gas supply rail or conduit or manifold part of the cannula(herein called a manifold part) between an open and a closedconfiguration. In the open configuration the prong is moved along themanifold part to be aligned with a user's nare in use, and be in fluidcommunication with the manifold part of the cannula via an aperture inthe manifold part. In a closed configuration the prong is moved alongthe manifold so that the prong is not in fluid communication with themanifold part, the being out of alignment from the aperture of themanifold.

The cannula may comprise a stop to limit the amount of movement of theprong.

The slidable prong may comprise a prong portion to be inserted into anare of the user, and a base portion adapted to receive the manifoldpart to slide thereon.

The base portion of the sliding prong may extend laterally from theprong portion to cover an aperture in the manifold.

The cannula may comprise a collapsible or crushable or squashable prongor portion including a prong. The collapsible or crushable or squashableprong may be squashed, collapsed or crushed to block flow from thatprong.

The cannula may comprise a foldable prong and a retaining member toretain the foldable prong in a folded position. In the folded positionthe prong is blocked or pinched off to prevent flow through the foldedprong, and is clear of the user's nare to allow access for an instrumentto be inserted.

Both prongs may be foldable.

The cannula may comprise two retaining members, each membercorresponding with one folding prong.

The cannula may comprises a tearable manifold part.

The manifold part may be tearable at a section located in between theleft and right nasal prongs. The torn section may be self sealing sothat 100% of the flow is directed via the single prong into one nare ofthe user when one half is torn from the cannula.

The cannula may comprise a first side comprising a first prong and aninlet for receiving a flow of gas, and a second side comprising a secondprong, wherein the first and second sides are separable. When the firstand second sides are connected together, the second prong is in fluidcommunication with the inlet.

The first side may comprise a valve or aperture that seals on itself, sothat when the second side is separated from the first side the flow fromthe inlet passes through the first prong, without flow through theaperture or valve.

Attachment of the second side to the first side may force or hold thevalve open so that the inlet communicates with the second prong.

The cannula may comprise a sealable aperture for inserting an instrumentthrough the cannula.

The aperture may be provided in a manifold part of the cannula inalignment with a nasal prong.

The cannula may comprise a valve, wherein the valve may be actuated fromopen to close by inserting an instrument through the cannula to preventflow to the prong that receives the instrument.

One or both prongs may be configured to be torn from a manifold part ofthe cannula, wherein the action of tearing a prong from the cannula actsto seal or close the manifold of the cannula so that there is no openingor outlet from where the prong is torn.

The cannula may comprise two respiratory gas supply conduits, oneconduit per side of the cannula, and wherein left and right sides of thecannula may be releasably connectable, and the left and right sides maynot be in fluid communication when connected together. The left or rightside may comprise a retaining member to hold the side of the cannula ina folded position to block flow from the corresponding supply conduit.

In accordance with at least one of the embodiments disclosed herein, acannula comprises an extendable region or expandable region positionedbetween a left prong and a right prong of the cannula. The expandableregion may comprise corrugations or concertina type sections. In someconfigurations, the expandable region of the cannula may be formed froman elastic material to stretch between an extended position and anon-extended position.

The cannula may be adapted to be used together with a dermal patch tohold the cannula in the extended position.

The cannula may comprise a frame that defines an extended position and aretracted position.

In accordance with at least one of the embodiments disclosed herein, acannula or face mask may be adapted to interface with an airwayinstrument, for example a scope or diagnostics instrument, or an airwaytube or conduit.

The cannula may comprise a guiding channel in an outer surface of thenasal prong.

The cannula may comprise a guiding channel in an inner surface of anasal prong. For example, a nasal prong may be a multi-lumen nasalprong, wherein a lumen provides for a gas flow and another lumenprovides for insertion of an instrument.

The guiding channel may extend along the length of one or both nasalprongs.

The guiding channel may extend laterally across the prong.

A face mask may comprise guiding channels for guiding instruments intothe airway of a patient, the channels may be provided at an inside ofthe mask. The guiding channels may be open channels or fully closedchannels. The mask may comprise one or more channels for guiding aninstrument into the user's mouth, and one or more channels for guidingan instrument into the user's nose.

An inside of the mask is coated with material to allow condensate todrain down surface, or has micro-channels in an internal surface of themask to help condensate drain down.

In accordance with at least one of the embodiments disclosed herein, apatient interface comprising a port for receiving an instrument toextend through the patient interface and into a patient's airway.

The port may be located on a manifold part of the interface.

The port may be located upon a nasal prong or upon each of a pair ofnasal prongs of the interface.

The interface or the port, or both, may further comprise a shaped orotherwise moulded region suitable for accepting or receiving or locatingor seating of the instrument relative to the interface or the port orboth.

The port may comprises a closable (or re-closable) opening.

The port may comprise of a self-closing seal.

The port may further comprise of an instrument director.

The director may provide for a pre-determined geometry of the port todirect, locate or portion the instrument at a desired angle ororientation relative to the port.

The port may include a relatively rigid component to support aninstrument upon insertion or entrance to the port.

The relatively more rigid component may provide a surface for positiveorientation or definition of a secure location or seating position foran instrument.

The relatively more rigid component may provide for a pre-determinedangle of insertion by the instrument to the port.

The port may comprises of a relatively softer or more flexible orcompressible component that seals over the port.

The port may comprise a covering of a relatively elastic or elasticatedcover material that stretches when the instrument is inserted and allowsextension, optionally a seal is said elastic or elasticated covermaterial.

The port may be formed of a combination of a relatively more rigidcomponent and a covering material of at least one layer of a relativelycompressible material.

The port may allow for insertion of a relatively long instrument.

The port may direct the instrument along a prong of the interface.

The port may be located on a nasal prong of the interface.

In accordance with at least one of the embodiments disclosed herein, acannula comprises a bite-block, the bite-block including an openingthrough which instruments may be provided into the patient's mouth.

In accordance with at least one of the embodiments disclosed herein, anasal cannula comprises a manifold for receiving a gas flow, and a pairof prongs extending from the manifold to deliver a gas flow to a patientvia the nares, wherein at least one prong is shaped or configured to i)reduce the amount of gas flow delivered to a corresponding nare ascompared to the amount of gas flow delivered by the other prong to theother nare, and/or ii) allow an airway instrument to be inserted into acorresponding nare. The nasal cannula may be configured as described inany one or more of the above statements relating to cannulas comprisingtwo nasal prongs.

According to those various embodiments and configurations describedherein, a flow rate of gases supplied or provided to an interface or viaa system, such as through a flowpath, may comprise, but is not limitedto, flows of at least about 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100,110, 120, 130, 140, 150 L/min, or more, and useful ranges may beselected between any of these values (for example, about 40 to about 80,about 50 to about 80, about 60 to about 80, about 70 to about 100 L/min,about 70 to 80 L/min). Flowrates above about 15 L/min in someembodiments may be used in such configurations or embodiments, inparticular but not limited to flowrates of about 60-70 L/min. ‘High flowtherapy’ may refer to the delivery of gases to a patient at a flow rateof between about 5 or 10 L/min and about 100 L/min, or between about 15L/min and about 95 L/min, or between about 20 L/min and about 90 L/min,or between about 25 L/min and about 85 L/min, or between about 30 L/minand about 80 L/min, or between about 35 L/min and about 75 L/min, orbetween about 40 L/min and about 70 L/min, or between about 45 L/min andabout 65 L/min, or between about 50 L/min and about 60 L/min.

According to various configurations and embodiments described herein,there may be provided a use of a flowrate of gases supplied or providedto an interface or via a system for the introduction or delivery of amedicament into a user's airway, for example, but not limited to, auser's upper or lower airway.

According to various configurations and embodiments, there may beprovided a therapy and/or a mechanism for using such relatively highflowrates to effectively drive or push medicament into the airway of auser. This may be due to the relatively high amount of force applied bysuch relatively high flowrates.

In various configurations or embodiments, the gases supplied to a userwhen provided at the flowrates above may provide for a jetting of thegas flow to carry or entrain medicament or particles or medicamentfurther or deeper into the airway of the user than other traditionalmethodology of delivering medicament or when a user is under normalself-driven respiratory conditions.

Each of the various configurations or embodiments or configurationsdescribed herein may be utilised in combination with one or more of theother various systems, devices (including interfaces) or methods alsodescribed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Specific embodiments and modifications thereof will become apparent tothose skilled in the art from the detailed description herein havingreference to the figures that follow, of which:

FIG. 1A illustrates a cannula with unequal length nasal prongs.

FIG. 1B illustrates an asymmetric cannula, wherein one side of thecannula is reduced in size.

FIG. 1C illustrates another asymmetric cannula, wherein one side of thecannula is reduced in size.

FIG. 1D is a front view of another asymmetrical cannula.

FIG. 1E is a plan view of the cannula of FIG. 1D.

FIG. 2 illustrates a cannula without nasal prongs.

FIGS. 3A and 3B illustrate a cannula with a sliding nasal prong that maybe moved between a retracted position and an extended position.

FIGS. 4A and 4B illustrate a cannula with an extendable nasal prong.

FIG. 5 illustrates a cannula with a tearable prong.

FIG. 6 illustrates a cannula with a slidable prong to expose an apertureto provide flow to a nare of patient via the aperture rather than by theslidable prong.

FIG. 7 illustrates a cannula with an opening that may be closed by acap.

FIGS. 8A and 8B illustrate a cannula with a rotating cuff to open andclose an aperture for providing flow to a nare of a patient.

FIG. 9 illustrates a cannula with a rotating prong.

FIG. 10 illustrates another cannula comprising a sliding nasal prong.

FIGS. 11A and 11B illustrate a cannula with a collapsible prong.

FIGS. 12A and 12B illustrate a cannula with a folding prong.

FIG. 13 illustrates a cannula with a removable prong.

FIGS. 14A and 14B illustrate a cannula with a tearable portion orsection to remove one half of the cannula.

FIG. 15 illustrates a cannula with two sides that may be separated.

FIGS. 16A and 16B illustrate a cannula with a port for inserting aninstrument along a prong of the cannula, and a one way valve for closingflow to the prong when an instrument is inserted.

FIGS. 17A and 17B illustrate a cannula with two sides that may beseparated.

FIGS. 18A and 18B illustrate a cannula with an expandable sectionbetween a left and right nasal prong.

FIGS. 19A and 19B illustrates a cannula with a channel for accommodatingan instrument.

FIG. 20 illustrates a face mask with channels for accommodatinginstruments.

FIG. 21 illustrates a respiratory gas conduit comprising instrumentconduits in a wall of the gas conduit.

FIG. 22 illustrates a cannula comprising a bite-block.

FIG. 23A illustrates a front partial perspective view of a nasal cannulainterface including a port to which an instrument may be inserted.

FIG. 23B illustrates an alternative arrangement and location of theportion of FIG. 23A, including a recess for receiving and locating aninstrument.

FIG. 23C provides the same view as 23B but shows a cannula including arecess for receiving and locating a medicament dispenser.

FIG. 23D illustrates a further alternative arrangement of a port on aninterface, including a cap for sealing the port from the surroundingenvironment.

FIG. 23E illustrates an instrument in-situ with a port by way of apartial cross-sectional view.

FIG. 23F shows a dispenser in-situ with a port by way of a partialcross-sectional view.

FIG. 23G shows a partial cross-sectional view of a cannula comprising aport and a medicament supply tube extending from the port to an outletend of a prong of the cannula.

FIG. 23H shows a partial cross-sectional view of another cannulacomprising a port and a medicament supply tube extending from the portto an outlet end of a prong of the cannula.

FIG. 23I shows a partial cross-sectional view of another cannulacomprising a port with a small diameter outlet to assist with dispersingmedicament.

FIG. 23J shows a cross-sectional view of a nasal prong with an innerextendible protrusion or secondary nasal prong including corrugations orconcertina-type arrangement.

FIG. 23K shows a cross-sectional view of a nasal prong with an innerextendible protrusion or secondary nasal prong including corrugations ora concertina-type arrangement allowing for extension of the protrusionor secondary prong from a less extended position (FIG. 23K-a) and a moreextended position (FIG. 23K-b)

FIG. 24A shows a partial cross-section view of a cannula comprising anasal prong with a port for accommodating access or insertion of amedicament dispenser into the flowpath of gases flowing through thenasal prong.

FIG. 24B shows a perspective view of an alternative cannula comprising anasal prong with a channel in an outer surface of the prong forinsertion of a dispenser.

FIGS. 25A, 25B show a reservoir provided in association with a gassupply conduit for supplying gas to a patient interface, the medicamentbeing released into the flowpath of the gas (FIG. 25A shows medicamentstored in the reservoir, FIG. 25B shows the medicament having beenreleased).

FIG. 26A shows an end view and a cross sectional side view of a nasalprong, and FIGS. 26B and 26C each show a cross sectional side view of anasal prong, the nasal prongs of these Figures comprising internalwalls/partitions or structures to divide a lumen and/or outlet of theprongs.

FIG. 27 shows an arrangement where a relatively long tube or conduit maybe utilised to separately dispense or direct a medicament into theairway of a user's, when a nasal prong in in-situ.

FIG. 28 shows a generalised diagram of a respiratory tract, includingthe upper respiratory region and the lower respiratory region.

DETAILED DESCRIPTION

In some instances it may be desirable to deliver a flow of respiratorygases to a patient via one or both nares and allow for the insertion ofairway instruments or devices, for example a tube, via one of the nares.In some instances it may be desirable to allow an instrument to beinserted via a nare of a user and optionally, to block flow to that nareof the user, or to block flow to both nares or stop flow completely.

In some embodiments, a nasal cannula may comprise an asymmetric profileto reduce the size of the cannula under or near one nare of a user. Forexample, with reference to FIG. 1A, in some configurations, a nasalcannula 10 comprises two nasal prongs 11, 12, wherein one of the nasalprongs 11 is shorter than the other nasal prong 12. The shorter nasalprong may have a relatively minimal or substantially no extension intothe nare of the patient. This arrangement provides room or space aroundthe shorter prong for a nasal instrument to be inserted into thepatient's nare. In some configurations, the cannula may comprise twoprongs, wherein each prong is of a length to have relatively minimal orsubstantially no extension into the nares of the patient, so that aninstrument may be inserted into either nare.

A cannula typically comprises a frame or manifold part. A conduit orinterface tube may be attached to the frame or manifold part. The frameor manifold part supports the nasal prongs in a spaced apart relationfor fitment into the patient's nares. The frame may optionally include apair of rigid or semi rigid arms that extend across the cheeks to locatethe cannula on the face. The arms may comprise an overmoldedthermoplastic or other suitable material. The cannula may comprise aheadgear to secure the cannula in an operational position on the user'shead. In some configurations the nasal cannula may comprise a securementstructure. A system for the securement of such a patient interface (e.g.nasal cannula) to the face can allow for a removable or connectablearrangement. For example, a securement structure or system may comprisea series of patches or pads, for connection to a user's face, and thenone or more additional pads or patches for connection to the interface,the exposed surfaces of these pads or patches being provided withcapability to connect or attach, preferably in a removable manner, tothe other patches or pads. With reference to FIGS. 1B to 1E, in someembodiments the frame 21 or manifold part 21 of the cannula 20 isasymmetrical so that the frame or manifold is reduced in size on oneside 21 a compared to the other side 21 b. The asymmetrical frame ormanifold provides a cannula with an asymmetric profile to provide spaceat one nare for an instrument to enter that nare. For example, withreference to FIG. 1B, in some configurations the frame or manifold 21tapers in size from one side or from one nasal prong 11, to the otherside or other nasal prong 12. In some embodiments, the frame or manifoldpart may be asymmetric when viewed from the front. In some embodiments,the frame or manifold part may be asymmetric when viewed in plan view.Plan view and front view are used with reference to the cannula in placeon a user and with the user in a standing or upright position. As shownin FIGS. 1B to 1E, in some embodiments, the frame or manifold part maybe asymmetric when viewed from the front of the cannula and also whenviewed in plan view. The side of the cannula that is reduced in sizeallows for an instrument to be inserted alongside the cannula and intothe nare of a user that is adjacent the reduced side of the cannula. Theframe or manifold part has a thickness extending between a backside ofthe cannula that locates against or adjacent the user's face below theuser's nose and an opposite outwards front side of the cannula, and aheight extending between a top of the frame or manifold part and abottom of the frame or manifold part. Preferably the prongs extend fromthe top of the frame. As shown in FIG. 1D, the height of the frame ormanifold part adjacent one nare of the user may be less than the heightadjacent the other nare of the user. Additionally or alternatively thethickness of the frame or manifold part adjacent one nare of the usermay be less than the thickness adjacent the other nare of the user.

In some embodiments the prong on the reduced in size side of the cannulamay be shorter in length than the other nasal prong (for example asshown in FIG. 1B), or cannula may comprise a prong-less nasal outlet onthe ‘reduced in size’ side of the cannula. Alternatively, in someembodiments the prongs are of equal or similar length (FIG. 1C), or theprong on the ‘reduced in size’ side of the cannula may be longer thanthe other prong.

In some configurations the nasal prong 11 at the ‘reduced in size’ sideof the cannula may have an oval cross section or a shape that is flatterthan a circle (for example as shown in FIG. 1E) to provide a spacebetween the prong and the user's nare for an instrument to be inserted.FIG. 1D illustrates an instrument inserted into the nare on the side ofthe cannula that is reduced in size. In some configurations the nasalprong 11 at the ‘reduced in size’ side of the cannula may be shorterthan the other prong 12, or the prongs may be of equal length.

An example of where a cannula comprising an asymmetric profile may beparticularly useful is in suspended laryngoscopy. Equipment associatedwith the suspended laryngoscope is placed very close under the patient'snares and in some cases a prior art high flow cannula cannot be used asthe cannula is too large to fit in place under the laryngoscope.

A gases supply tube or conduit may be connected to the cannula, or thecannula may comprise a conduit connection for connecting a supply tubeor conduit. In some embodiments, the supply conduit or conduitconnection may be provided to a side of the cannula opposite to thereduced side of the cannula, as shown in FIGS. 1B to 1E. Thisarrangement of the conduit away from the reduced side of the cannulafurther assists in maximizing space for an airway instrument or otherdevice to be provided to the user's nare.

Unless otherwise indicated, one side of the cannula is intended to meanthe portion of a cannula that is located on one side of a user's face inuse (e.g. a left hand side of a user's face). An opposite side of thecannula is the portion of the cannula that is located on the other sideof a user's face in use (e.g. a right hand side of a user's face). Theterms “left” and “right” are intended to relate to the left hand sideand right hand side of the user or patient.

In some embodiments, as illustrated in FIG. 2, a cannula 30 does nothave a nasal prong. Such a cannula comprises a manifold part or frame 31that receives a flow of gases and redistributes that flow to each nareof a user via two outlets or apertures 32, each outlet correspondingwith (or configured to communicate with) a nare of the user.

The embodiments described above may be useful as they may not requireany adjustment of the cannula on the user's face in order to insert aninstrument into a nare of the user, yet a flow of gases is stilldelivered to both nares.

In some configurations a ‘frame’ of a cannula may comprise a strap ormay be a strap for securing the cannula in place on a patient's face inuse.

In some configurations a nasal cannula comprises a removable orextendable prong. For example, with reference to FIGS. 3A and 3B, atleast one prong 41 is retractable into or extendable from a manifold 43of the cannula 40. In FIG. 3A an extendable prong 41 is in an extendedposition, and in FIG. 3B the prong is retracted into the manifold 43.For example, the prong slides into and out of the manifold of thecannula. One or both prongs 41, 42 may be configured to be extendable,for example both prongs may slide into and out of the manifold of thecannula.

As illustrated in FIGS. 4A and 4B, in some configurations one or bothprongs 51, 52 of the cannula 50 comprises corrugations or concertinatype sections 53 which can be extended by a user to lengthen to extendthe length of the prong, as shown in FIG. 4A. The corrugations may beformed at a base of the prong, or partway or fully along the length ofthe prong. To avoid clashing with an airway instrument the prong may beconfigured to a retracted position, as shown in FIG. 4B.

As illustrated in FIG. 5, in some configurations one or both prongs 61,62 may be configured to be torn from a manifold part 63 of the cannula60. To create space for an instrument to be inserted into a nare of theuser, one prong may be torn from the cannula, to leave an opening oroutlet for gases to flow to the corresponding nare of the user.Alternatively, in some configurations, for example as shown in FIG. 13,one or both nasal prongs 141, 142 may be removably attached to amanifold part 143 of the cannula 140. To create space for an instrumentto be inserted into a nare of the user, one prong 141 may be releasablydetached from the cannula 140. The prong may be releasably reattachedfor future use. The releasable prong may be permanently attached to thecannula assembly, for example by a lanyard or leash 144.

As illustrated in FIG. 6, in some configurations one or both prongs 71,72 may be slidable or rotatable relative to the other prong or to amanifold part 73 of the cannula, to displace the prong from a user'snare in use to provide access for an instrument to be inserted into thenare left vacant by sliding the prong. For example, as illustrated inFIG. 6, in some configurations a nasal cannula may comprise a gas supplyrail or conduit (manifold part) 73, and one prong 71 may be slidable onthe rail or supply conduit 73. The slidable prong may comprise a prongportion 71 a to be inserted into a nare of the user, and a base portion71 b adapted to receive the manifold part to slide thereon. Where theprong is slid out of alignment with a user's nare, an orifice oraperture 74 in a wall of the rail or conduit is exposed and may providesome gas flow from the rail or conduit to the exposed nare of the user.With the prong slid out of alignment with the user's nare, space iscreated to allow an instrument to be inserted into the exposed nare. Insome embodiments both prongs 71, 72 may be slidable on a rail or supplyconduit or manifold of the cannula.

The embodiments described with reference to FIGS. 3A to 6 and FIG. 13maintain delivery of respiratory gas flow to both nares, while providinga cannula that is flexible in terms of treatment options, for example:

-   -   Change may be temporary and respiratory support can be restored        when instrument/device is not in use.    -   Change can be achieved easily and without removing interface.    -   As flow through both nares is maintained some flow may be able        to enter the nare around instrument/device. This may help to        keep the nare/airway patent and also allow minimal change in        respiratory support.    -   Flow through one nare may be maintained by one prong as flow and        delivered pressure to that nare does not change. This may avoid        higher velocity jets that may damage nasal tissue, as is the        case where all flow is redirected to one nare.

Allowing the flow to continue to flow through both orifices may preventlarge pressure changes in the system. If the gas supply is sensitive topressure changes (e.g. a blower) this may also help to reduce potentialfluctuations in flow and/or humidity, or a reduction in flow if thesupply is not able to overcome the increase in pressure.

As illustrated in FIG. 7, in some configurations flow to one nare may beoptional, while flow to the other nare may be permanently provided. Inthe embodiment of FIG. 7, the cannula 80 comprises one nasal prong 81 toprovide a flow of gas to a nare of a user, and an opening or aperture 82in a manifold 83 of the nasal cannula that may be capped or plugged by acap 84. Flow to one nare is provided optionally by capping or uncappingthe opening. In an alternative embodiment the nasal cannula may comprisea pair of outlets, wherein the outlets are prong-less.

As shown in FIGS. 8A and 8B, in some embodiments a cannula 90 maycomprise a rotatable cuff 91 to block or unblock an opening or aperture92 on a manifold 94 of the cannula to optionally provide a flow of gasto one nare of the user. The rotatable cuff has an aperture 93 to alignwith the manifold aperture 92 to allow flow from the manifold aperture92 to the user's nare. The nasal prong 95 maintains flow permanently tothe other nare. FIG. 8A shows the cuff 91 rotated to block the opening92 and prevent flow to one nare, and FIG. 8B shows the cuff 91 rotatedto unblock the opening 92 by aligning the cuff aperture 93 with themanifold aperture 92 and allow flow to the nare. The blocking of oneoutlet may assist a clinician to insert a nasal instrument into the narethat corresponds with the occluded outlet.

The embodiments described with reference to FIGS. 7 and 8A/8B maintaindelivery of respiratory gas flow to at least one nare, while providing acannula that is flexible in terms of treatment options, for example:

-   -   The user can optionally block the flow to one of the nares.    -   The change may be temporary.    -   The change can be achieved easily and without removing the        interface.    -   A prong is absent from one nare allowing instruments to be        inserted at all times without having to alter the interface.    -   The choice of providing flow to the nare causes minimal        interference with the nare; even if flow is provided through the        opening, there is reduced or no physical obstruction to an        instrument inserted into the nare.    -   Where flow is permitted through the opening (i.e. flow is        delivered to both nares), some flow may be able to enter the        nare around the instrument/device. This may help to keep the        nare/airway patent and also allow minimal change in respiratory        support.    -   If the opening is blocked, flow may be redirected to the main        prong, maintaining total flow delivered to the patient and        pressure delivered to the lower airway.    -   The ability to block the opening/gas flow means lightweight or        sensitive instruments can be used without gas flow interfering        with alignment.

With reference to FIGS. 9 to 16B, in some configurations flow to onenare may be optionally provided via a nasal prong. Flow to the othernare may be permanently provided via a nasal prong. As shown in FIG. 9,in some configurations a nasal cannula 100 comprises a rotatable prong101. One or both prongs may be rotatable. The prong may be rotatable ona gas supply rail or conduit or manifold 104 part of the cannula (hereincalled a manifold part). In an open configuration the prong 103 isrotated to be aligned with a user's nare in use, and be in fluidcommunication with the manifold part of the cannula via an aperture 102in the manifold part. In a closed configuration the prong 103 isrotated, for example rotated forward from the user's face, so that theprong is not in fluid communication with the manifold part as the prongis rotated out of alignment from the aperture of the manifold. In theclosed position the prong is moved out of alignment with the user's nareto provide access into the nare for an instrument to be inserted. In theclosed configuration, 100% of the flow is directed via the single pronginto one nare of the user. In some embodiments both prongs 103, 105 maybe rotatable on a rail or supply conduit or manifold of the cannula, sothat a user may choose which prong to rotate and which nare to insert aninstrument.

As shown in FIG. 10, in some configurations a nasal cannula 110comprises a slidable prong 111. The prong 111 is slidable on a gassupply rail or conduit or manifold part 113 of the cannula (hereincalled a manifold part). In an open configuration the prong is movedalong the manifold part to be aligned with a user's nare in use, and bein fluid communication with the manifold part of the cannula via anaperture 114 in the manifold part. In a closed configuration the prongis moved along the manifold so that the prong is not in fluidcommunication with the manifold part as the prong is moved out ofalignment from the aperture of the manifold, as shown in FIG. 10. In theclosed position the prong is moved out of alignment with the user's nareto provide access into the nare for an instrument to be inserted. In theclosed configuration, 100% of the flow is directed via the single pronginto one nare of the user. Movement of the prong in one direction alongthe manifold part may be limited by a stop 115, to prevent the aperture114 in the manifold becoming uncovered. Movement of the prong in anopposite direction along the manifold part may be limited by a stop orby the other prong 112, to set the alignment of the sliding prong withthe aperture. The slidable prong 111 may comprise a prong portion 111 a,to be inserted into a nare of the user, and a base portion 111 b adaptedto receive the manifold part to slide thereon. The embodiment of FIG. 10is similar to the embodiment of FIG. 6, however in FIG. 10 the baseportion 111 b of the sliding prong 111 extends laterally from the prongportion 111 a to cover the aperture 114 so that the aperture is blockedby the base portion when the prong portion is not aligned with theaperture. In some embodiments both prongs are slidable prongs, eachslidable on a manifold part of the cannula.

In some configurations, a cannula has a first prong attached to and influid communication with a first conduit part, and a second prongattached to and in fluid communication with a second conduit part,wherein the second conduit part is slidable relative to and in fluidcommunication with the first conduit part to displace the second prongfrom the first prong. In some embodiments, as illustrated, the secondconduit part comprises an aperture in a side wall to align with thefirst prong when the second prong is positioned for alignment with anare of the user, so that the first prong is in fluid communication witha flow of gases provided via an inlet of the cannula.

As shown in FIGS. 11A and 11B, in some configurations a cannula 120 maycomprise a collapsible or crushable or squashable prong or portionincluding a prong. The collapsible or crushable or squashable prong 121is squashed, collapsed or crushed to block flow from that prong. Whenthe prong is squashed, collapsed or crushed it is clear of the user'snare to allow access for an instrument to be inserted. In someconfigurations both prongs may be collapsible or crushable orsquashable.

As shown in FIGS. 12A and 12B, in some configurations a cannula 130comprises a foldable prong 131 and a retaining member 133 such as a clipto retain the foldable prong in a folded position. In the foldedposition the prong is blocked or pinched off to prevent flow through thefolded prong, and is clear of the user's nare to allow access for aninstrument to be inserted. In some configurations both prongs may befoldable. The cannula 130 may comprise two retaining members, eachmember corresponding with one folding prong.

As shown in FIGS. 14A and 14B, in some configurations, a cannula 150comprises a tearable manifold part 153. The manifold part is tearable ata section 154 located in between the left and right nasal prongs. Thetorn section may be self-sealing so that 100% of the flow is directedvia the single prong into one nare of the user when one half is tornfrom the cannula.

As shown in FIG. 15, in some configurations, a cannula 160 may comprisea first side 161 comprising a first prong 162 and an inlet 163 forreceiving a flow of gas, and a second side 164 comprising a second prong165, wherein the first and second sides are separable. The first prongis in fluid communication with the inlet. When the first and secondsides are connected together, the second prong is in fluid communicationwith the inlet. The first side also may comprise a valve 166 or aperture166 that seals on itself, so that when the second side is separated fromthe first side the flow from the inlet passes through the first prong,without flow through the aperture or valve. Attachment of the secondside to the first side forces or holds the valve 166 open so that theinlet communicates with the second prong.

As shown in FIGS. 16A and 16B, in some configurations, a cannula 170comprises a sealable aperture 173 (for example an aperture and a valve)for inserting an instrument through the cannula. The aperture 173 sealsaround an instrument when inserted into the aperture, and closes in asealed configuration when the instrument is removed from the aperture.Such an aperture 173 may be provided to any one of the nasal cannulasdescribed herein. The aperture may be provided in a manifold part of thecannula in alignment with a nasal prong so that an instrument may beinserted through the aperture and along the prong into a user's nasalpassage. The aperture may also be provided in the manifold without beingin alignment with a prong, such that the instrument may be inserted intothe manifold without extending into or along the prong.

In some embodiments, the cannula comprises a valve 174. The valve may beactuated from open to closed by inserting an instrument through thecannula. The valve may be located within the manifold part of thecannula and between the prongs or outlets of the cannula. The valve isclosed by the instrument extending through a second prong of the cannulaso that gas flow from an inlet of the cannula is directed to a firstprong of the cannula. When the instrument is inserted through theaperture the instrument actuates a valve element (e.g. a flap) against avalve seat to fluidly isolate one nasal prong or outlet from the othernasal prong or outlet and stop or reduce flow to the prong that receivesthe instrument. In some configurations, the cannula may comprise twosealable apertures, each aperture aligned with a corresponding prong.The cannula may comprise two valves, each valve corresponding with aprong. In such an embodiment, an instrument may be insertedsimultaneously via both nares of the user. In some embodiments, thecannula may comprise a pressure relieve valve in the event that flowfrom both nasal prongs or nasal outlets is blocked.

In some configurations, one or both prongs may be configured to be tornfrom a manifold part of the cannula. However, unlike the configurationdescribed with reference to FIG. 5, in some embodiments the action oftearing a prong from the cannula could act to seal or close off the flowconduit provided by the cannula so that there is no opening or outletfrom where the prong is torn.

The nasal cannula configurations described with reference to FIGS. 9 to16B allow for easier interfacing with a nasal instrument. Specificallythe nasal instrument can be interfaced with the nasal cannula at theregion of the prong that is modified or manipulated, for example bymoving a prong out of the way of the user's nare as described. Thecannulae therefore may be manipulated or modified so they interface withnasal instruments inserted into at least one nare while still being ableto maintain high flow therapy delivery via the other nare. Theembodiments described with reference to FIGS. 9 to 16B maintain deliveryof respiratory gas flow to at least one nare, for example high flowdelivery of respiratory gas, while providing a cannula that is flexiblein terms of treatment options, for example:

-   -   the user can optionally block the flow to one of the nares,    -   change may be temporary,    -   change can be achieved easily and without removing interface,    -   can be configured so that flow or prong does not interfere with        an instrument,    -   when prong is oriented to be clear of the nare, flow is directed        to the other prong, maintaining total flow and pressure        delivered to the user.

Furthermore, in all embodiments, the arrangement described for modifyingor manipulating one nasal prong may be applied for modifying ormanipulating both nasal prongs, for example if access to both nares isdesired. Where both nasal prongs or outlets can be blocked, a pressurerelief valve may be provided to limit a maximum pressure that the systemmay be exposed to.

With reference to FIGS. 17A and 17B, in some configurations flow to thecannula 180 may be provided by two respiratory gas conduits 183, 184,one conduit per side of the cannula, or in other words each nasal prong181, 182 has a dedicated gas supply. The left and right sides of thecannula may not be in fluid communication when coupled together as shownin FIG. 17A. In such embodiments, a left side and a right side of thecannula may be releasably connectable. Where insertion of an instrumentis not required, the left and right sides of the cannula may be clippedor connected together and respiratory gas provided from the left andright nasal prongs to both nares of the user. Where an instrument is tobe inserted, the left and right sides may be disconnected, and one ofthe sides used to provide the flow of gas via a nare of the user.

In some embodiments, the left and right sides of the cannula may be influid communication when coupled together as shown in FIG. 17A. Where aninstrument is to be inserted, the left and right sides may bedisconnected. The side of the cannula not in use may be placed away fromthe user's face, and may be folded to pinch the flow of gas to close offthe flow of gas to the side of the cannula not being used. The side ofthe cannula not in use may be held in a folded position by a retainingmember 185 or clip. Or the removed side may remain open and flow stillallowed to flow, for example where a reduced flow to the patient isacceptable or if the instrument is to be inserted into the patient'snare for a short time period. Alternatively, the cannula may comprise avalve in each side of the cannula that is configured between an openstate and a closed state by connecting and disconnecting the sides ofthe cannula. The valve may close when the sides of the cannula aredisconnected. When an instrument is removed from the user's nare the twosides may be reconnected and gas supply via both nares may resume.

With reference to FIGS. 18A and 18B, in some configurations a cannula190 comprises an extendable region or expandable region 193 positionedbetween a left prong 192 and a right prong 191 of the cannula. Theexpandable region may comprise corrugations or concertina type sectionswhich can be extended by a user to lengthen or to extend the length ofthe prong, as shown in FIG. 18B. In use, where an instrument is to beinserted in a nare of the user, the expandable region may be expanded toan expanded or extended position as shown in FIG. 18B to vacate theuser's nare. Where no instrument is required, the expandable region maybe in the retracted or non-extended position as shown in FIG. 18A toprovide a flow of gases to both nares of the user.

A cannula may be secured in place on a user's face by a dermal patch. Adermal patch may be adhered to a user's face, for example by adermatologically sensitive adhesive. A second patch (interface patch)may be attached to a face side of a cannula. The dermal patch and theinterface patch each have one half of a two-part releasable connection,for example one patch may have the hooks of a hook and loop connectionand the other patch may have the loops of a hook and loop connection(for example the connection may be Velcro®). Thus the patches retain thecannula in position on the user's face. In some configurations, where adermal patch is used to secure the cannula in place on the users face,the cannula 190 may be held in the extended position (FIG. 18B) or inthe retracted position (FIG. 18A) by the dermal patch. Alternatively,the expandable region may be rigid enough to allow the extended side ofthe cannula to be disconnected from its dermal patch and beself-supported in the expanded position, or folded away from thepatient's face.

In some configurations, the expandable region 193 of the cannula may beformed from an elastic material to stretch between an extended positionand a non-extended position. In use, where no instrument is required,the expandable region may be in a non-stretched state so that bothprongs interface with the nares of the user. Where an instrument is tobe inserted, the expandable region formed from elastic material may bestretched to an extended position and held in the extended or stretchedposition by a dermal patch that is attached to the user's face. Thecannula may be held in the stretched state by a dermal patch asdescribed above. Alternatively, the cannula may comprise a frame thatdefines an extended position and a retracted position. For example, inthe expanded condition (FIG. 18B) the cannula may be clipped to a frameto retain it in the expanded position.

The embodiments described with reference to FIGS. 17A to 18B maintainflow to one nare of the user, and is configurable to displace a prongaway from the other nare of the user. Where a prong is displaced fromthe user's nare, gas flow to the cannula may not be directed to theother single prong, which may be advantageous in some circumstances asthis arrangement may avoid a higher velocity jet of gas into the user'snare due to directing all flow to a single prong, like in embodiments ofFIGS. 9 to 16B. The various embodiments allow for easier interfacingwith a nasal instrument via the nare corresponding to the prong that ismanipulated (e.g., moved or removed from the user's nare).

In some embodiments, a patient interface such as a cannula or face maskmay be adapted to interface with an airway instrument, for example ascope or diagnostics instrument, or an airway tube or conduit. Tointerface with an airway instrument a cannula may comprise a guidingchannel to receive and guide the instrument. For example, as illustratedin FIG. 19A, in some configurations, a cannula 200 may comprise aguiding channel 203 along the length of one or both nasal prongs 201,202, and/or on a manifold of the cannula. As illustrated in FIG. 19B, insome embodiments a prong 202 may have a guiding channel 203 extendinglaterally across the prong. As shown in FIGS. 19A and 19B, in someembodiments the guiding channel is formed in an outer surface of thenasal prong. In some configurations, the guiding channel may be formedin an inner surface of a nasal prong. For example, a nasal prong may bea multi-lumen nasal prong, wherein a lumen provides for a gas flow andanother lumen provides a port or conduit for insertion of an instrument.With multiple lumens the insertion of a device or instrument may notcause a large increase in back pressure as one lumen is dedicated to thepassage of the device or instrument while another lumen provides aflowpath to the user's airway.

FIG. 20 illustrates a face mask 210 which includes guiding channels 211,212 for guiding instruments into the airway of a patient provided at aninside of the mask. The guiding channels may be open channels (like212), or fully closed channels (like 211). That is, in someconfigurations the guiding channel may be a tubing conduit along whichthe instrument may be threaded. In the embodiment of FIG. 20, theguiding channels are curved to guide flexible instruments into thepatient's airway. A channel may be provided to guide an instrument intothe user's mouth, and another channel to guide an instrument into theuser's nose. An inside of the mask may be coated with material designedto allow condensate to drain down the surface. This would help a usersee inside the mask to guide instruments. Alternatively the mask mayhave micro-channels in an internal surface of the mask to helpcondensate drain down.

A face mask (e.g. nasal mask or full face mask) includes a seal to sealagainst the face of a user. In some configurations, a face mask may havethinned portions in the seal on one side or on all sides. The thinnedportions in the seal allow for a tube or other airway instrument to beinserted, and may allow for a seal to be created over the tube orinstrument. The thinned portion of the seal may be more malleable andpliable and hence may conform to the shape of the tube while stillmaintaining a seal. The tube may be a nasogastric tube (NG or NT tube,e.g., a tube inserted through the nostrils).

Patient interfaces may have entry ports for instruments to be insertedthrough the interface and into a patient's airway. For example, as shownin FIG. 21, a nasal prong or other respiratory gas conduit 220 maycomprise instrument ports or conduits 221 formed in a wall 222 of theprong or gas conduit, the instrument conduits extending longitudinallyalong the prong or gas conduit. The conduits 221 provide a lumen alongwhich an instrument may be threaded to be guided into the patient'sairway. A face mask may comprise two instrument ports, one for insertingan instrument to a patient's mouth, and a second port for inserting aninstrument into the patient's nose. The ports may be closed by a valve,for example a duck billed valve, if necessary to prevent leaking ofbreathing gases via the port.

In some embodiments, as illustrated in FIG. 22, a cannula 240 may beprovided with a ‘bite-block’ 241. The bite block is an item that isinserted into a patient's mouth and on which the patient may bite downbut which holds the patient's mouth open. The block includes an openingthrough which instruments may be provided into the patient's mouth, andprevents a patient from biting an instrument.

The various embodiments described above may be particularly suitable foruse with a range of instruments or airway instruments, including airwaytubes or conduits, oral or nasal catheters, drug (medicament) deliverydevices (eg: spray bottle, atomiser device, syringe), surgicalinstruments including spatulas, introducers/bougies, stylets, guides,tube exchangers, oral/nasal endotracheal tubes, nasopharyngeal airways(nasal trumpets), and scopes or diagnostics instruments such aslaryngoscopes (direct or video) endoscopes, rigid or flexiblebronchoscopes, esophagoscopes and fibreoptic scopes.

A patient interface 230, such as a nasal cannula, may comprise of a port232 for delivery of a medicament into a flow F of a fluid (such as agas) being delivered to a user and/or for interfacing with a medicamentdelivery device or an instrument. When a delivery device (dispenser)interfaces with a patient interface (e.g. nasal cannula) the dispensermay be used to dispense medicament into a flow path (e.g. a patient'sairways) with or without a flow of fluid applied to the patient'sairways via the cannula.

The medicament may optionally include one or more excipients, such aspharmaceutically acceptable excipients. Such a medicament may be thosesuitable for being administered to the airway of a user, whether as anatomised, nebulised or dispersed or other form suitable to be introducedinto a flow of gas for administration and/or delivery to a user.

In some configurations, the port 232 may allow an instrument 1000 (e.g.a tube) or a medicament dispenser 234 (e.g. a spray bottle, atomiserdevice or syringe) to be insert thereto for dispensing of saidmedicament. For example, the port 232 may be located upon a manifoldpart 236 of the interface 230 such that dispensing of the medicamentprovides for dispersal into a relatively high flow rate of gas providedto the user, and which can carry the medicament into an airway of theuser. For example, see FIG. 23A. Delivery of the medicamentsimultaneously with the delivery of high flow may help to deposit themedicament far down into the patient's airway (for example to thepatient's vocal cords), reducing the chance of the medicament beingdeposited prematurely within the patient's airway (for exampledepositing in the patient's nasal cavity).

Other instruments that the port 232 may be adapted to interface withinclude airway tubes or conduits, introducers/bougies, stylets, guides,tube exchangers, and scopes or diagnostics instruments such asendoscopes, rigid or flexible bronchoscopes, esophagoscopes andfibreoptic scopes.

Alternatively, in still further embodiments, the port 232 may beprovided upon one prong or as a feature of or integrated as a part of apair of nasal prongs 233. For example, see FIG. 24A. For example, theport may be provided on a prong near a base of the prong.

In some configurations, the patient interface 230 may comprise of ashaped or otherwise moulded region 237 suitable for accepting orreceiving or locating or seating of a medicament dispenser 234 orinstrument 1000 to the interface 230. For example, in this manner adispenser 234, such as a syringe, may be seated for greater or moreaccurate placement or control of its placement relative to the interface230 which is located upon the user. A depression 237 in a manifold part236 may be provided for such a seating or location of an instrument 1000and/or a dispenser 234. For example, see FIGS. 23B and 23C. A depression237 may act as a keyway to receive a corresponding key of the instrumentor dispenser to correctly orientate the instrument or dispenser to thecannula. Alternatively, the interface may comprise a protrusion thatprovides a key to be received in a corresponding keyway of theinstrument or dispenser.

In some configurations, the port comprises a closable opening 235 (e.g.shown in FIG. 23C), such as, but not limited to, a screw-cap or apush-fit cap. Alternatively, the port 232 may be a luer-type connectionor may comprise of a valve that seals over an opening of the port 232when the dispenser 234 is not connected or inserted. For example, aduck-bill type valve may be utilised to improve sealing or closure ofthe port 232 and to reduce likelihood of gas leaks from such a port 232.

In some configurations, the port 232 may further comprise of a directoror guide 238. The director or guide 238 may be used to direct aninstrument more accurately, for example towards or up through a nasalprong 233, for example as shown in FIG. 23E. In some configurations, thedirector or guide may be a flow director or medicament director orguide. Such a director 238 may be used for directing dispensedmedicament or a nozzle or outlet of a dispenser 234 more accurately, forexample toward or up through one or more nasal prongs 233, to minimisethe amount of medicament dispensed onto the interior side walls of theinterface 230 or wall parts more associated with the port 232, whichotherwise may not reach the user. Such a director or guide 238 may be ageometry of the port 232 or other protrusion shaped to direct thedispenser 4 or an outlet therefrom to a desired angle or position whenin-situ with the port 2. For example, see FIG. 23F. With reference toFIG. 23F, the guide or director 238 (instrument or device director, ormedicament director) may comprise a wall 238 extending from the port232. The guide or director 238 may extend from the port 232 within alumen or flowpath of the cannula 230. The guide or director 238 mayextend from the port towards a nasal prong 233 within the flowpath ofthe cannula. The wall 238 may be an annular wall extending from the portthrough which the medicament or device or instrument passes into theflowpath of the cannula 230. For example, the guide may form a tubularstructure extending from the port within the cannula. The guide 238 maybe configured to provide a clearance between the guide 238 and themedicament delivery device 234 or the instrument 1000 to prevent orreduce friction between the guide and the medicament delivery device orthe instrument as the medicament delivery device or the instrument isinserted into the cannula via the port 232. Further, in someconfigurations the port is configured to provide a clearance between theport and the medicament delivery device 234 or the instrument 1000.Therefore in some configurations the guide and the port do not rigidlyhold the instrument or dispenser in a fixed position relative to thepatient interface. The device may slide freely into the cannula (andpossibly into the patient's airway) via the port and the guide. Theguide or director 238 may be formed of a relatively rigid material toadditionally form a relatively rigid component 239 (compared with otherparts of the patient interface) to support an device or a dispenser, asdescribed below.

In some configurations, the port 232 may provide for an opening whichprovides for a relatively rigid component 239 (compared with other partsof the patient interface) to support an device 1000 or a dispenser 234(e.g. such as a syringe tip) upon insertion or entrance to the port 232(such as a port provided upon a manifold). Such a relatively more rigidcomponent 239 can allow for a user to apply a force against the port 232while inserting an instrument or undertaking a dispensing of medicament(or at least configuring such a dispenser relative to the interfaceand/or user for subsequent dispensing a medicament). Provision of arelatively more rigid component 239 may assist in a positive and/or moredefined or more secure location or a more positive seating of aninstrument or a dispenser 234 to the interface 230 and port 232. A nasalcannula may comprise a resilient material for contacting the user,beneath the user's nose and/or the user's nares. For example nasalprongs are preferably formed of a resilient material to be inserted intothe user's nares. In some embodiments, the relatively more rigidcomponent is more rigid than the resilient material of the cannula. Insome embodiments the rigid component 239 may be integrated into thecannula by overmoulding of the resilient material of the cannula.

In some configurations, the port comprising a relatively more rigidcomponent provides for a pre-determined angle of insertion by theinstrument or the dispenser to the port. In this manner, such arelatively rigid component requires a device (e.g. instrument ordispenser) to be successfully inserted to the port at a particularangle, such an angle may be that which may more accurately allowinsertion of the instrument or dispenser or delivery of the medicament.

In some alternative configurations, the port 232 may comprise of arelatively softer or more flexible or compressible component that sealsover the port 232 when not in use. Such a component can optionallyprovide for a seal about an instrument or a dispenser 234 or parts ofthe dispenser 234 (e.g. such as the tip of a syringe) when theinstrument/dispenser 234 is inserted into the port 232. A seal may helpminimise or reduce leaks between the device and the port 232 when theyare operationally engaged, optionally particularly so during amedicament dispensing operation.

In some embodiments, the port 232 may be covered by a relatively elasticor elasticated cover material that stretches when theinstrument/dispenser is inserted and allows extension. Such a cover mayprovide for a seal. A small cut or opening in the end of the elastic orelasticated cover is normally in a closed configuration and can seal theport 232 when relaxed, preventing leak; and when an instrument/dispenseris inserted into the port 232 and pushed through the elastic orelasticated cover, the cut or opening may be stretched over the end ofthe instrument/dispenser, thereby being opened sufficiently to allow forthe instrument or dispenser to be inserted and/or medicament to bedispensed/deposited through it.

In still further alternative configurations, the port 232 may be formedof a relatively more rigid component or a material covered by, orsurrounded by at least one layer of a relatively compressible material.In this manner, when the instrument or dispenser is inserted into theport 232, the relatively softer or compressible materials could becompressed or be conformable to the shape of the immediate surfaces ofthe instrument or dispenser, thereby assisting to promote a sealingaround the instrument or dispenser. This can allow for the instrument ordispenser to remain substantially supported by the relatively more rigidcomponent 239 or the structure underneath, yet provided with a sealingcapability about a perimeter or other portion of the port 232 whichbecomes engaged or operatively in contact with the instrument ordispenser.

In some embodiments, the port 234 is adapted or configured to allow fora relatively long, thin instrument or medicament dispenser, such as aconduit or tube, to be inserted or to be ingressed into the port 232.Such a dispenser can then be extended to project along at least a lengthof or through the flowpath of the patient interface 230 or a componentsuch as a gas supply conduit associated with the interface 230.Optionally, such a medicament dispenser may terminate at the outlet fromone or more of said nasal prongs 233, alternatively such a medicamentdispenser may terminate within the nasal cannula (i.e. upstream of theoutlet from one or more nasal prongs) or may terminate at a positionbeyond the outlet of the one or more nasal prongs 233 (i.e. downstreamof the outlet from the one or more nasal prongs). In some configurationsoutlet of the dispenser may terminate at a small distance beyond theoutlet of a nasal prong downstream of the nasal cannula. For example, asmall distance may be a distance that is less than an internal diameterof the outlet of the nasal prong, or less than twice the internaldiameter of the outlet of the nasal prong, or a distance less than halfthe length of the nasal prong.

In some embodiments the nasal cannula may comprise a medicament supplytube that extends from the port so that medicament may be deliveredfurther downstream from the port 232, for example, as illustrated inFIGS. 23G and 23H. The supply tube 243 may extend from the port 232located at the manifold 236 of the nasal cannula to an outlet end 233 aof the nasal prong 233, so that the medicament is dispensed from thecannula at or adjacent to an outlet of the prong into a patient'sairway. As shown in FIG. 23G, in some embodiments the supply tube 243may be formed within a wall of a nasal prong. For example, a supply tubemay be over-moulded into the wall of a prong. The supply tube may beformed in a curved or otherwise shaped configuration prior tointegration into the wall of the prong. In FIG. 23G the tube 243 isillustrated positioned along an upper side of the prong. In someembodiment the tube may be positioned in the wall of the prong to locateat least an outlet end of the tube towards an inward side of the prong,so that the outlet end of the tube is near or adjacent to the patient'sseptum in use. An inward side of a prong is a side of the prong thatfaces towards or bears against a patient's septum in use (or facestowards the other prong of the cannula). In some embodiments the tube243 may be located along an inside wall surface of the prong, forexample along an inside wall surface on an inward side of the prong.

In an alternative embodiment as shown in FIG. 23H, the supply tube 243may be located or positioned within a lumen of the nasal prong, forexample centrally within the prong so as to typically not press againsta user's nare during use. The tube may be curved or otherwise shaped tofollow or corresponding with a shape of the lumen of the prong. The port232 may provide a recess 244 for receiving an outlet or nozzle of adispenser to dispense medicament into the supply tube for delivery tothe patient's airway. Alternatively, the port 232 may comprise aprotrusion or male connector to be received within a nozzle or outlet ofa dispenser. In some embodiments the port may be formed by an inlet endof the supply tube 243 to receive a nozzle or outlet of a dispenser. Insome embodiments the port may be provided by an inlet end of the supplytube 243 that is to be received in a nozzle or outlet of a dispenser,such as an aerosol canister. The supply tube may extend from themanifold a distance so that the dispenser may be connected to the supplytube remotely from the manifold.

As shown in FIGS. 23G to 23I, in a preferred embodiment the port 232 isprovided on a wall of the cannula that faces away from the face of apatient in use. For example, in FIGS. 23G to 23I, the port 232 isprovided on a front wall 236 a of the manifold 236 of the cannula. Thefront wall is opposite to a rear wall that is in contact with oradjacent the upper lip or philtrum of the patient in use. With the portin a front wall of cannula the port is presented facing away from thepatient's face is use, to provide unobstructed access to the port by amedical professional, for applying a dispenser to the port.

Preferably the supply tube 243 comprises a small diameter outlet 243 a,such that the outlet operates as a nozzle or spray nozzle to assist withdispersing the medicament into a flowpath of the cannula or thepatient's airway, either with or without a flow of gases provided by thecannula. For example, the supply tube may have an outlet with aninternal diameter of less than 2 mm, or less than 1 mm. The diameter ofthe supply tube outlet is preferably substantially smaller than theinternal diameter of a nasal prong. For example, the nasal prong mayhave an internal diameter of 4 mm or 5 mm or greater than 5 mm. Theinternal cross sectional area of the spray tube outlet may be less than20% or 10% of the internal cross sectional area of the outlet of a nasalprong of the nasal cannula. In a preferred embodiment the tube 243 has asmall diameter relative to the internal diameter of the nasal prong. Insome embodiments the tube 243 has a constant cross section along itslength. Preferably the spray tube is formed of a relatively rigidmaterial to retain its shape during use, for example a curved shape tocorrespond with a curvature of the nasal prong 233.

Alternatively, in some further embodiments, connection or insertion of adispenser to the port 232 may promote a protrusion (e.g. such as a lumenprovided) to extend along and through one or more nasal prongs 233. Insuch a manner, there can be allowed for a deposition of a medicamentfurther downstream from the port 232, or alternatively closer to theairway of a user. For example, if a long dispenser is instead usedrather than a syringe tip (i.e. as was used in FIG. 23F).

In some embodiments, insertion of the dispenser may promote a protrusion2310 to extend from the port 232 (e.g. at least as an extension throughthe nasal prong 233). See for example FIG. 23J, such a protrusion 2310may be attached to the inside of the patient interface (e.g. the port232 or an inner part of the interface, such as a manifold, or as a partof a nasal prong 233). Such a protrusion 2310 may comprise ofcorrugations or other concertina-type arrangements that can unfold andextend to allow an extension and the protrusion 2310 to extend beyond orpast the end of one or a pair of nasal prongs 233, or other structuresassociated with a patient interface 230 so that the medicament may bedeposited further into the user's airway, or at another preferredposition along the flowpath of the cannula or user's airway. Such aprotrusion can be an extendible lumen, optionally such a protrusion maybe curved or shaped to fit comfortably into the nasal anatomy.

In some embodiments, when in an extended position, the protrusion 2310allows for maintenance of the flowpath through the cannula or of a flowof gases to one or a pair of nasal prongs 233 of the cannula 230. In yetother embodiments, when in an extended position, the protrusion 2310 mayengage with one or a pair of nasal prongs 233 or the flowpath to one oreach said nasal prong 233 so as to block a flow of gases to one bothnasal prongs of a pair of nasal prongs.

Alternatively the insertion of the dispenser 234 may promote aprotrusion 2310 to extend into a nasal prong 233 or a flowpathassociated with a nasal prong, blocking the flow of gases to the uservia that flowpath. See for example FIG. 23K. FIG. 23K-a shows a firstconfiguration in which a protrusion 2310 is relatively unextended, whileFIG. 23K-b shows a further configuration in which the protrusion 2310 isin a relatively more extended position. Such a configuration in whichthere is a reduced flow or a block entirely of a flowpath may beadvantageous in situations where the delivered flow of gases (e.g.litres per minute) exceeds the user's inspiratory demand. In this case,excess gas flow escapes the nares during inspiration and medicamentcarried on this gas flow may be less effectively communicated to theuser or may be wasted entirely and not directed to the user's airway. Insome instances, medicament may be undesirably expelled into the room,such as a surgical theatre or pre-operative room. In this embodiment theflow of gases to the nasal prongs 233 can be blocked in the prong itselfand thereby the prong stops delivering the gas—in this way,preferentially, only medicament will be directed to enter the user'snare (i.e. no gas flow). Blocking the flow may also allow the user toaccurately control the deposition of the medicament into the patient'sairway without interference from the flow of fluid. The gas flow fromthe blocked prong will exit through the other prong, or such gas flowmay be relieved via a pressure relief valve or other arrangement or suchdevice. Alternatively, the cannula may comprise a valve to block flow tothe cannula when the dispenser is inserted. For example the cannula maycomprise a valve with a valve element such as a flap that is moved to aclosed position against a valve seat when the dispenser is inserted.

There may be a relatively high force required to cause the protrusion2310 to extend. If the user wishes to allow high flow to continue duringmedicament delivery the user may insert the dispenser along theprotrusion 2310 but not push so hard as to cause the protrusion toextend and block the flowpath through the cannula. The protrusion may beformed to tighten onto the dispenser when the dispenser is inserted intoor through the protrusion. In this way, when the dispenser is retractedback through the protrusion to remove the dispenser from the nasalcannula the protrusion is pulled back to its original, unblockedposition. For example, the protrusion may be formed from a soft/and orcompressible or resilient material that tightens around the dispenserwhen inserted.

In some embodiments, a scavenging mechanism or system may be utilised inconjunction with the patient interface 230 as described herein. Such asystem may be utilised to collect exhaled gases from a user, includingexhaled medicament which has not been absorbed or taken-up by the user.Such a system may comprise a recirculation system including filtration,for re-delivery of the collected gases and medicament to the user. Sucha mechanism attached to the patient interface could cover the user'smouth and/or nose to prevent medicament being exhaled back into a room.In particular, such a mechanism or system:

-   -   could use a one way valve attached to additional conduit that        delivers that exhaled flow back to the system    -   could allow the system to ‘scrub’ the excess medicament from the        gas flow, thereby assisting in minimising wastage    -   could be embodied in a face mask that is placed over a nasal        cannula—such a face mask may be placed on the user during        medicament delivery times.

In some embodiments, a nasal cannula may be designed to have one or bothprongs 233 relatively long, such that they extend relatively deep intothe user's nasal cavity. Optionally, one or both nasal prongs may becurved to conform to nasal geometry, for example this may allow forimproved capabilities of successfully delivering administered medicamentinto the user's airway.

In various alternative configurations, one or both of a pair of nasalprongs may be extendable or comprises portions which are extendible inlength, such as a protrusion 2310. For example, a nasal prong maycomprise of an inner secondary prong portion, such as a protrusion 2310which may comprise of corrugations or concertina-type sections which canbe extended to lengthen and allow such a secondary prong to projectfurther than a main nasal prong into a user's airway. Such an extendedsecondary prong may be utilised as a protrusion for improved forextending of the flowpath for delivery of medicament to a user's airway.In various instances, see FIG. 23J as an example, the prongs may utilisesuch a secondary prong that can be extended when the user wants todeliver a medicament, or when the user is asleep and can tolerategreater discomfort. Longer prongs may also have the additional benefitof creating greater flushing of the airway and potentially furtherreducing CO2 from a user's airways.

In some embodiments, the port 232 may be a guiding channel or othershaped accommodation region for allowing improved access to the nares bya dispenser 234 without affecting the delivery of respiratory support.For example, the port may be a channel 203 in an outer surface of theprong as described above with reference to FIG. 19B, one or both nasalprongs 233 shaped to accommodate the shape of a dispenser 234 or atleast the dispensing tip of a dispenser. For example see FIG. 24B.Alternatively, a nasal prong 233 may comprise a port 232 oraccommodation region 233 through which a dispenser 234 may be insertedfor delivery of medicament to the gas flow F and/or into a user'sairway—see for example FIG. 24A.

In some configurations there is a pre-formed medicament dispenserpre-loaded with medicament for use with the patient interface asdescribed above.

In some embodiments, the dispenser 234 may be pre-formulated with apre-determined quantity of medicament in a ready-to-dispenseconfiguration. For example, lignocaine may be provided in a dispenser234 in a pre-determined quantity for administration to a user.

In some embodiments, the dispenser may be provided with the cannula toensure correct fit with the port(s). Or an attachment/adaptor may beprovided to fit to existing dispensers, for example to attach to the endof a syringe.

In some embodiments, the patient interface 230 may comprise of areservoir 2312 for receiving and/or storing of a medicament. In otherembodiments, the reservoir 2312 may be actuated manually or by otherforms (e.g. such as by an electronic dosing or administrationarrangement which allows for release of the medicament from thereservoir into the flowpath for delivery to the user). The reservoir maybe permanently attached and refillable by the user, or be detachable andattached when desired.

Where the dispensing of medicament may be manually actuated by a user,this may for example be by way of a button on the interface or bydepressing a syringe plunger. Such actuation can allow for the releaseof the medicament from the reservoir 2312.

In one example, actuation may result in the medicament being forced orencouraged to release out of reservoir and into the flowpath of theinterface or a flowpath associated with the interface (e.g. that of agas supply conduit). For example in FIG. 25A the reservoir enablesmedicament to be delivered into the flow F of gases being directed to auser's airway; while FIG. 25B shows the medicament having been releasedinto the flow and being directed toward the interface 230. The reservoirmay be made of a non-rigid material that may be squeezed to force themedicament to open a valve and release the medicament into the flow pathof the conduit. The valve may be biased to a normally closed position sothat the valve closes when the reservoir is not squeezed to force thevalve open.

As high gas delivery flow rates may be used, the medicament may becarried in the gas stream to the user's airway.

For example, according to those various embodiments and configurationsdescribed herein, a flow rate of gases supplied or provided to aninterface or via a system, such as through a flowpath, may comprise, butis not limited to, flows of at least about 5, 10, 20, 30, 40, 50, 60,70, 80, 90, 100, 110, 120, 130, 140, 150 L/min, or more, and usefulranges may be selected between any of these values (for example, about40 to about 80, about 50 to about 80, about 60 to about 80, about 70 toabout 100 L/min, about 70 to 80 L/min).

Such relatively high flowrates of gases may assist in providing thesupplied gases into a user's airway, or to different parts of a user'sairway, for example such flowrates may allow for a delivery of suchgases to the upper, middle or lower airway regions.

Such relatively high flowrates can assist to, in combination with amedicament delivered to the flowpath or the flow of gases beingdelivered to the user, provide assisted delivery of medicament to auser's airway, or different parts of a user's airway. For example, suchrelatively high flowrates may effectively help drive or push medicamentfurther into a user's airways than under normal respiratory conditionsby the user.

FIG. 28 shows a typical airway of a person, and includes arrows toindicate the path of how a relatively high flowrate of gases supplied toa user may be utilised to effectively push or drive the supplied gasesfurther or deeper into a user's airway than when the person is undernormal or typical self-driven respiratory conditions.

If liquid medicament is used, the gas flow may help to partiallynebulise the medicament into smaller particles that can carry furtherdown the airway. A valve may be provisioned to sit between the reservoirand a main gas supply conduit, such that the valve is normally closed.However, actuation of the reservoir may be used to put the valve underpressure (e.g. by squeezing or button actuation (not shown)) with thevalve consequently opening and allowing the medicament to be madeavailable for release into the gas stream (see FIG. 25B)

In alternative configurations, the medicament in the reservoir 2312 maybe released or made available to the flowpath by actuation of a negativepressure in the flowpath, thereby opening a valve or other member whichmay be sealing the reservoir from the flowpath. For example, if thepatient were asked to inhale deeply a valve or seal can be opened andmedicament released. The valve or seal may be designed such that normaltidal breathing does not create enough negative pressure to open it. Inthis way medicament delivery can also be timed with inspiration,avoiding wastage and encouraging the medicament to travel further downthe airway particularly when the patient inhales deeply.

In still further embodiments, where a valve or seal is used to close offthe reservoir, the aperture of the valve may be designed to be small andcreate nebulised particles of a certain size that enable medicamentdelivery to a specific location.

In other configurations, details of the above embodiments could beapplied here as well however the medicament may be delivered via anotherchannel, not necessarily through the nasal prongs. Such a channel may besized differently to the prongs e.g. may have a smaller internaldiameter to create high gas/medicament velocities and effectively jetmedicament further down the user's airway than the prongs mightotherwise be able to achieve. The channel could use gas delivered via asidestream or other source of gas from the main gas flow, a separate gasflow or from another pressurized source, for example an aerosolcanister, or may not deliver gas and only be used as a medicamentdelivery port. In this manner:

-   -   there could be multiple channels for delivery of medicament        (e.g. different medicament through each separate channel).    -   a different medicament could be delivered through each channel,        or prong, at the same time.    -   flow through each channel/prong could be independently        controlled to manage each medicament concentration or        administration separately.

In other configurations, the port 232 that dispenses the medicament(e.g. whether the port is located on the patient interface or as a porton a conduit associated with the gas flow) could be designed so thatwhen liquid medicament is dispensed through it, the medicament isatomised. For example, inside one or each nasal prong 233 there could beserrations/ribs or walls/partitions 242 as shown in FIGS. 26A and 26C,and/or the opening or outlet of the nasal prong could be made of manysmall apertures instead of a single one large outlet, as shown in FIGS.26A and 26B. Forcing or directing liquid through such features mayassist in breaking the liquid up into small droplets with a lower weightthan a large liquid bolus. Alternatively, such structures as shown inFIG. 26A to 26C may cover only a portion of the cross-sectional area ofthe prong or prong outlet.

According to the configuration above, reducing particle size of themedicament being dispensed to a user can aid the medicament to becarried in the gas flow and delivered to the user. For example, theforce of a depressed syringe containing liquid medicament or anautomated piston, depressing the medicament through the features couldbe used to create the atomization or nebulisation (i.e. turning themedicament into particles or reducing medicament particle size). Assuch, nebulised or reduced particle sizes could be sized to targetdeposition at the larynx, or other desired locations depending on thetarget for the medicament.

In some configurations, the port 232 on the interface 230 could comprisea single aperture but sized so as to cause nebulisation or atomizationof liquid medicament when it is administered into and dispensedtherefrom (i.e., the port may have a relatively small exit aperturethrough which dispensed medicament must pass, e.g. less than 1 mmdiameter). For example, as shown in FIG. 23I, the port may comprise asmall diameter outlet 232 a so that as medicament is dispensed from amedicament delivery device into the port 232 the medicament is atomizedor sprayed into the flow path of the nasal cannula, for example into themanifold of the cannula. In the case of a nasal cannula, one of theprongs 3 may have a relatively small inner diameter or includeserration/ribs or the opening or outlet of the nasal prong could be madeof many small apertures instead of a single one large outlet so as toeffect such an in-line atomisation or nebulisation of medicament, asdescribed above with reference to FIGS. 26A to 26C.

In some configurations, the reservoir 2312 may be provided as a part ofthe patient interface, or may be associated with a gas supply conduit(e.g. that conduit supplying gas to the patient interface) or may beprovided as a reservoir at a source device for providing a gas flow tothe patient interface. It will be appreciated the medicament may bedelivered via main gas path or could be provided via a separate conduitup to interface.

Dispensation of medicament can be controlled via mechanically actuatedvalve or by software. (e.g. mechanical actuation or may beelectronically controlled).

In various configurations, the delivery or dispensing of medicament canbe timed to coincide with a user's inspiration, or a part of theinspiratory phase, to avoid wastage during exhalation phase of breath.As such, delivery of medicament may be timed to occur at the peak ofinspiration to ensure the most flow possible is travelling down theuser's airway and to encourage deep deposition. For example, ifmedicament delivery was desired during inspiration a population averageof inspiratory pressures could be determined and a valve associated withthe reservoir designed to open at pressures below this value. Medicamentcould be actuated by a pressure in a main gas conduit, or if a separateline was run next to the main gas conduit and terminated in the user'snares, then this could also be triggered in a similar way.

Alternatively, the inspiration phase could be detected by measuring theinterface pressure or pressure at some place in the system and themedicament delivery could be activated (e.g. by opening a valve,controlled by software) when the pressure falls below a pre-determinedvalue, such as the (rolling) average. A pressure below the averagepressure would indicate the user is causing a reduction in the pressurein the system and is therefore inspiring. The average could becalculated over a set number of breaths (e.g. 5 breaths) or time (e.g. 1minute).

In other configurations, if the medicament delivery conduit does nothave gas flow through it the release of medicament could be activatedvia an additional electrically activated piston or other release system.Alternatively, delivery could be timed to activate with a certaininspiratory flow rate that matches a flow most likely to carry themedicament down the airway to deposit at the vocal cords (or otherdesired location). More specifically, if the medicament were deliveredas part of the main gas flow, the gas flow could also be controlled tomeet inspiratory demand to avoid wastage of medicament with high flowrates in excess of the inspiratory demand and to ensure delivery of thecorrect amount of medicament.

In yet other configurations:

-   -   High flow rates may be used to deliver dry powder medicaments.        This may be desirable for depositing medicament in the nasal        airway where blood flow is high and medicament may be quickly        absorbed into the blood stream via the thin epithelium layer.    -   An anti-coagulant may be added to powders. This may prevent the        powder from caking and potentially blocking the medicament        delivery port. This may be particularly important when the        powder is delivered via a humidified gas conduit.

Alternatively the powder may be delivered via a separate conduit thatmay use the same gas source as the main gas supply, or a side-streamsupply of it, but is not humidified.

Delivery via other airway equipment may be utilised, for example anattachment could be fitted to end of a laryngoscope to allow fordelivery of medicament into a user's airway without requiring anadditional medicament delivery device (e.g. atomiser or nebulisersetc.).

Still further, in other configurations it may be possible to:

-   -   Coat the medicament in a chemical that has a half life that        degrades after set time (e.g. if it is known that at 70 litre        per minute it takes 0.5 seconds for flow to reach the larynx,        use a coating that will degrade sufficiently after 0.5 s).    -   Coat the medicament in a chemical that degrades on contact with        preferential tissue or materials, such as vocal cord tissue. For        example, the vocal cords epithelium is stratified squamous        epithelium. This type of epithelium is also present in the oral        cavity and the nasal vestibule; however the rest of the        conducting portion is lined by respiratory epithelium. If        medicament is delivered via a nasal cannula, this avoids the        oral cavity. If the delivered medicament is delivered at        sufficient velocity and in a manner directed past the nasal        vestibule, the majority of it should get past the nasal        vestibule. Hence it may pass down to the vocal cords before        coming in contact with any other stratified squamous epithelium,        and deposit at this location.    -   Nasal prong length could be extendable or adjustable for        delivery of medicament further into airway. For example, with        corrugations at the base of a nasal prong, similar to FIG. 23J.        Again a dispenser (e.g. a syringe r other forms of a dispenser)        could be inserted into the prong, and in doing so, could        activate the prong length extension.    -   The flow rate could be adjusted for a short time (e.g. one        breath, or part of a breath) during medicament deposition, to        encourage deposition on the larynx. For example, the flow rate        could be increased for a short time to increase flow velocity        and jet medicament further down the airway. This could be timed        with inspiration to help medicament flow down the airway. Or, it        may be found that the current flow rate (e.g. 70 lpm) may cause        the medicament to be deposited too far down the airway, so the        flow may need to be reduced when medicament deposition is        desired/activated. Flow rate may be adjusted manually by a user        as medicament is dispensed.    -   The medicament polarity could be determined, or the medicament        could be electrically polarised to be attracted to magnets. A        magnet could be placed behind the user's neck while supine at        the position of the desired medicament deposition location to        attract the medicament to deposit there as it travels down the        airway.

Another embodiment is explained in FIG. 27. In this case the deliveredgas flow may help to force the liquid medicament onto the back of thelaryngeal wall as it travels down. FIG. 27 shows an arrangement where arelatively long tube or conduit 2313 may be utilised to separatelydispense or direct a medicament delivered from a dispenser or areservoir (not shown) into the airway of a user, when a nasal prong 233of a patient interface 230 is simultaneously also in in-situ with a nareor nares.

In further configurations:

-   -   Medicament could be delivered as (gas-filled) bubbles. Bubbled        delivered through prongs or additional medicament delivery        channel. Prong diameter, or medicament channel diameter could be        sized to control the diameter of the bubbles and encourage        deposition at the larynx, or other location.    -   Medicament bubbles could be delivered orally. The airway has a        decreasing cross-section diameter as it extends towards the        vocal cords from the mouth if the patient's mouth is open wide.        Thus if the patient is asked to keep their mouth open and the        bubble diameter is the same size as the trachea at the position        of the vocal cords, the bubbles may travel down the airway and        burst only at the vocal cords as they come into contact with an        area the same size as them, depositing the medicament there.

The medicament could be delivered via a coaxial conduit. The liquidmedicament is pushed along the outer layer and flow is passed throughthe centre. The liquid medicament may form a film over the end of theconduit (e.g. prongs) when no flow is passed through it. When flow isre-started this may allow a bubble to form at the end and be pushedalong with the gas stream. As an example, if two conduits are used (e.g.separate gas supply to a pair of nasal prongs) the flow may be deliveredalternately through each conduit and a film may be able to form over theother conduit when flow is not delivered. Bubbles can thus be deliveredalternately from each conduit/prong.

Bubbles may be filled with a composition of gases that target depositionin a certain location. For example helium, nitrogen, and/or oxygen maybe used to create a stokes number that targets deposition on the vocalcords taking account of the flow rate, medicament composition andparticle drag, and oral/nasal anatomy.

In further configurations:

-   -   Once a user is reclined the medicament may delivered via a        liquid bolus (rather than aerosolized).    -   If the bolus is delivered while the patient is supine the effect        of gravity may allow the medicament to flow down the back of the        throat to the vocal cords.

The foregoing description of the invention includes preferred formsthereof. Modifications may be made thereto without departing from thescope of the invention.

The term “comprising” as used in this specification and claims means“consisting at least in part of”. When interpreting each statement inthis specification and claims that includes the term “comprising”,features other than that or those prefaced by the term may also bepresent. Related terms such as “comprise” and “comprises” are to beinterpreted in the same manner.

To those skilled in the art to which the invention relates, many changesin construction and widely differing embodiments and applications of theinvention will suggest themselves without departing from the scope ofthe invention as defined in the appended claims. The disclosures and thedescriptions herein are purely illustrative and are not intended to bein any sense limiting.

The invention consists in the foregoing and also envisages constructionsof which the following gives examples only.

What is claimed is:
 1. A nasal cannula configured to deliver a flow offluid to a user, the nasal cannula comprising: a manifold part, themanifold part having an inlet configured to receive the flow of fluid,and at least one outlet configured to deliver the flow of fluid to oneor both of the user's nares, wherein the at least one outlet comprisesat least one non-sealing patient interface, wherein the manifold partincludes a patient-contacting surface and the inlet is located on alateral side of the manifold part adjacent the patient-contactingsurface; and a port located on the manifold part, the port configured toperform at least one of: delivering a medicament into the flow of fluidbeing delivered by the nasal cannula to the user, or interfacing with amedicament delivery device, wherein the port comprises an opening, theopening being at least one of closable or re-closable, and wherein thenon-sealing patient interface comprises a non-sealing nasal prong thatextends proximally, a path through the port being aligned with a flowpath through the nasal prong of the nasal cannula.
 2. The nasal cannulaas claimed in claim 1, wherein the port comprises a guide for directinga flow of medicament into the flow of fluid, or for directing themedicament delivery device into at least one of the nasal cannula or theuser's airway.
 3. The nasal cannula as claimed in claim 2, wherein theguide provides for a pre-determined geometry of the port to direct,locate, or position the medicament delivery device, or an outlet of themedicament delivery device, at a desired angle or orientation relativeto the nasal cannula.
 4. The nasal cannula as claimed in claim 1,wherein the port extends from the manifold part to the nasal prong ofthe nasal cannula, or wherein the nasal cannula further comprises asecond port and a second non-sealing nasal prong, the port and thesecond port extending from the manifold part to the nasal prong and thesecond nasal prong respectively.
 5. The nasal cannula as claimed inclaim 1, wherein the port is arranged to face away from the user's facewhen in use.
 6. The nasal cannula as claimed in claim 1, furthercomprising a moulded or otherwise shaped region configured foraccepting, receiving, locating, or seating of the medicament deliverydevice relative to the port.
 7. The nasal cannula as claimed in claim 1,wherein with the medicament delivery device in-situ with the port, theport seals about the medicament delivery device.
 8. The nasal cannula asclaimed in claim 1, wherein the port comprises of a seal, the seal beingself-closing.
 9. The nasal cannula as claimed in claim 1, wherein theport comprises a rigid component configured to support the medicamentdelivery device when in-situ with the port.
 10. The nasal cannula asclaimed in claim 1, wherein the nasal cannula or the port comprises aplurality of in-line atomisation or nebulisation of medicamentdispensers, the plurality of in-line atomization or nebulization ofmedicament dispensers configured to deliver medicament via the port. 11.The nasal cannula as claimed in claim 10, wherein the plurality ofin-line atomization or nebulization of medicament dispensers comprise aplurality of ribs or serrations within a nasal prong of the nasalcannula.
 12. The nasal cannula as claimed in claim 1, further comprisinga medicament supply tube extending from the port.
 13. The nasal cannulaas claimed in claim 12, wherein the supply tube is formed within a wallof the nasal prong of the nasal cannula or located within a lumen of thenasal prong.
 14. The nasal cannula as claimed in claim 12, wherein aninlet end of the supply tube is located at the port or extends from theport so as to allow the medicament delivery device to be connected tothe port remotely from the manifold part.
 15. The nasal cannula asclaimed in claim 12, wherein the supply tube comprises a small diameteroutlet such that the outlet operates as a nozzle to spray or otherwisedisperse the medicament from the supply tube.
 16. The nasal cannula asclaimed in claim 1, wherein the port is adapted to receive a nozzle oran outlet of the medicament delivery device or to be received in thenozzle or the outlet of the medicament delivery device.
 17. The nasalcannula as claimed in claim 1, wherein the port is located on a side ofthe manifold part opposite another side of the manifold part where theat least one outlet is located.
 18. The nasal cannula as claimed inclaim 1, wherein the nasal cannula is configured to perform one or moreof: delivering the flow of fluid to the user to provide high flowsupport; delivering the flow of fluid at a flow rate of above 15 L/min;or delivering the flow of fluid that comprises a humidified gases flow.19. A nasal cannula configured to deliver a flow of fluid to a user, thenasal cannula comprising: a manifold part, the manifold part having aninlet configured to receive the flow of fluid, and at least one outletconfigured to deliver the flow of fluid to one or both of the user'snares, wherein the at least one outlet comprises at least onenon-sealing patient interface, wherein the manifold part includes apatient-contacting surface and the inlet is located on a lateral side ofthe manifold part adjacent the patient-contacting surface; and a portlocated on the manifold part, the port configured to perform at leastone of: delivering a medicament into the flow of fluid being deliveredby the nasal cannula to the user, or interfacing with a medicamentdelivery device, wherein with the medicament delivery device in-situwith the port, the port seals about the medicament delivery device, andwherein the non-sealing patient interface comprises a non-sealing nasalprong that extends proximally, a path through the port being alignedwith a flow path through the nasal prong of the nasal cannula.
 20. Anasal cannula configured to deliver a flow of fluid to a user, the nasalcannula comprising: a manifold part, the manifold part having an inletconfigured to receive the flow of fluid, and at least one outletconfigured to deliver the flow of fluid to one or both of the user'snares, wherein the at least one outlet comprises at least onenon-sealing patient interface, wherein the manifold part includes apatient-contacting surface and the inlet is located on a lateral side ofthe manifold part adjacent the patient-contacting surface; and a portlocated on the manifold part, the port configured to perform at leastone of: delivering a medicament into the flow of fluid being deliveredby the nasal cannula to the user, or interfacing with a medicamentdelivery device, wherein the port comprises of a seal, the seal beingself-closing, and wherein the non-sealing patient interface comprises anon-sealing nasal prong that extends proximally, a path through the portbeing aligned with a flow path through the nasal prong of the nasalcannula.